Accuracy of the concentration of morphine infusions prepared for patients in a neonatal intensive care unit
Accuracy of the concentration of morphine infusions prepared for patients in a neonatal intensive care unit
复制标题
DOI：
10.1136/archdischild-2013-304522
复制
发表时间：
2013-12-01
影响因子：
5.2
通讯作者：
Arenas-Lopez, Sara
中科院分区：
文献类型：
--
作者：
Aguado-Lorenzo, Virginia;Weeks, Kevin;Arenas-Lopez, Sara
目的了解新生儿吗啡输液与标签规格的关系，比较新生儿重症监护病房（NICU）与药房配制的吗啡输液与标签规格的差异。方法收集6周内未使用的吗啡输液，采用高分辨力比色法测定其浓度。结果病房护士配制的输液中有19.2%和药房配制的输液中有7.8%超出英国药典规定的限度（± 7.5%）。此外，在病房制备的输注液中发现超过20%的浓度偏差，尽管这是由小于0.2 mL的体积差异引起的。在药房制备的输液中发现的偏差的频率和幅度低于NICU制备的输液。后者显示出超出质量标准的样品数量显著更高（p=0.015）;然而，在两种设置中均发生了与预期浓度的偏离。药房和NICU之间对于小于0.5 mL或小于1 mL的体积的显著差异未确定，可能是由于样本量小，结论目前用于大龄儿童和成人的规格输液的制备实践涉及在注射器中稀释小体积，并导致新生儿输注的最终浓度不准确。使用.我们建议对这一患者群体实施标准浓度，以有效消除这些误差。
Objective To investigate the accuracy of morphine infusions prepared for neonates in relation to the label strength and to identify the differences in deviation between infusions made in neonatal intensive care unit (NICU) and those dispensed ready-to-use from pharmacy.Methods Unused portions of morphine solution for infusion were collected over a 6-weeks period and used to determine the concentration of the drug by high-performance liquid chromatography (HPLC).Results A total of 19.2% of infusions prepared by nurses in the ward and 7.8% prepared in the pharmacy were outside the limit required by the British Pharmacopoeia (+/- 7.5%). Moreover, a deviation in concentration of more than 20% was found in ward-prepared infusions, although this was caused by volume discrepancies of less than 0.2 mL. The frequency and magnitude of deviations found in infusions prepared in pharmacy was lower than in those prepared by NICU. The latter showed significantly higher number of out-of-specification samples (p=0.015); however, deviations from intended concentration occurred in both settings. Significant differences between pharmacy and NICU for volumes of less than 0.5 mL or for less than 1 mL were not identified probably due to small sample size, but statistical data show a trend for differences.Conclusions Current practice of preparation of infusions from strengths intended for older children and adults involves dilution of small volumes in a syringe and leads to inaccuracy in the final concentration of infusions for neonatal use. We propose the implementation of standard concentrations for this patient group to effectively eliminate these errors.